Anesthesiology clinics
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Anesthesiology clinics · Jun 2011
ReviewNew concepts in acute pain management: strategies to prevent chronic postsurgical pain, opioid-induced hyperalgesia, and outcome measures.
Chronic postsurgical pain (CPSP) is a pain syndrome that has attracted attention for more than 10 years. CPSP is a pain syndrome that develops postoperatively and lasts for at least 2 months in the absence of other causes for pain (eg, recurrence of malignancy, chronic infection, and so forth). Pain continuing from a preexisting disease is not considered as CPSP. In this article, the authors discuss the etiopathogenesis of CPSP and interventions that can help prevent and treat this condition.
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Anesthesiology clinics · Jun 2011
ReviewComplications of regional anesthesia and acute pain management.
Perioperative nerve injuries are recognized as a complication of regional anesthesia. Although rare, studies suggest the frequency of complications is increasing. Risk factors include neural, traumatic injury during needle or catheter placement, infection, and choice of local anesthetic solution. ⋯ Body habitus and preexisting neurologic dysfunction may also contribute. The safe conduct of regional anesthesia involves knowledge of patient, anesthetic, and surgical risk factors. Early diagnosis and treatment of reversible etiologies are critical to optimizing neurologic outcome.
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The incidence of neurologic damage after regional anesthesia is rare. However, this complication may have dramatic consequences for the patient because recovery may take several months. As nerve conduction studies and electromyography are the cornerstones of investigations in cases of postblock deficit, it is mandatory for the anesthesiologist performing regional anesthesia to have a basic understanding of these tests to discuss the cause with the surgeon and inform the patient about the prognosis.
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Anesthesiology clinics · Jun 2011
ReviewUltrasound-guided regional anesthesia for peripheral nerve blocks: an evidence-based outcome review.
Ultrasound-guided regional anesthesia (UGRA) has increased in popularity over the past 5 years. This interest is reflected by the plethora of publications devoted to technique development, as well as randomized and controlled trials. Despite the excitement around ultrasonography, skeptics argue that there is a lack of evidence-based medicine to support the unequivocal adoption of UGRA as a "standard of care." This article summarizes and critically assesses current data comparing traditional approaches to localizing nerves with those that use ultrasound guidance. In addition, the potential benefits of UGRA that go beyond current information available from comparative studies are explored.
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Pain after major abdominal, orthopedic, and thoracic surgeries can be significant causing unacceptable morbidity. Poorly controlled pain results in patient dissatisfaction and may also be associated with major morbidities, including perioperative myocardial ischemia, pulmonary complications, altered immune function, and postoperative cognitive dysfunction. ⋯ Recent literature supports the use of regional anesthesia in the form of various peripheral nerve blocks as a better alternative. This article discusses the role and evidence for wound infiltration analgesia in general surgery, orthopedic surgery, neurosurgery, and thoracic surgery.